What’s Causing Your Asthma?

Could it be one of these non-allergic asthma triggers?

by Stephen Apaliski, MD

While allergic asthma trig­gers only cause problems for people who are allergic to them, non-allergic triggers can be called equal opportunity offenders. What do I mean by this?
When you are allergic, it is like
having the key that turns the switch that starts the engine of asthmatic in­flammation. No key (no allergy), no inflammation.

With non-allergic triggers (espe­cially the irritants listed below), no
key is necessary. The irritant itself pushes a start button that turns the
engine on directly. In short, if you
have asthma, any of the triggers listed here can harm or affect you. You need not be allergic.

Irritants Chemical Odors Many people with asthma cannot use cleaning agents with strong odors without triggering their asthma. Using lower irritant cleaners
or delegating the task to someone else if possible (now that’s a side benefit!) are the two means of avoiding these potent triggers.

There are some individuals, how­ever, who work in jobs and industries where exposure to chemicals happens often. Certain chemicals in the work­place produce occupational asthma. Symptoms associated with occupa­tional asthma are worse when you are at work, and better when you’re away from it. If you discover a connection between worsening asthma and chemi­cals used in your job, you will need to either use a specialized breathing pro­tection device (like a respirator) in the workplace, or you may actually have
to change jobs to prevent serious long-term health problems.

Perfumes and Scents Asthma
can be triggered by breathing in the fumes that these substances give off. These are not just perfumes or colognes that you spray or daub on your body. Also included are the scents that may accompany the detergents, soaps, and lotions you use to care for your skin
or clothes. Unscented versions of these products are plentiful in the market­place, and they are worth seeking out to ensure that you don’t unintentionally trigger your asthma.

Tobacco smoke and asthma do not mix.
If you have asthma, you absolutely should
not smoke.

Of course, sometimes you may
end up on the elevator with someone drenched in perfume or cologne. The best approach here is to quickly put as much clean air space between you and the offending agent as you can. This may mean stepping to a new spot in
the elevator or exiting the elevator on the next floor.

Smoke Tobacco smoke and asthma do not mix. If you have asthma, you absolutely should not smoke. Similarly, if you live with a smoker, that person should smoke outside the home, and never while riding in your vehicle.
Neither rolling down a car window
nor cracking open the back door of
the house while someone is smoking
is going to do the trick.

Other potential sources of smoke exposure include campfires, wildfires, and fireplaces, as well as some bars
and restaurants, although over time fewer and fewer commercial establish­ments are allowing smoking indoors.

Air Pollution Here in Texas, espe­cially in the summertime when the air is hot and there is very little wind, we have elevated ozone levels in the air. Unfortunately, this phenomenon is not limited to Texas; elevated ozone levels can be seen in many parts of the nation, especially in urban areas.

Ozone, a gas that cannot be seen
or smelled, is a respiratory tract irri­tant, even to people without asthma. For convenience, the government grades ozone levels from green to
yellow, orange, and red, where green represents the lowest level, and red,
the highest level.

Ozone levels seem to be at their highest levels during traffic rush hour in the late afternoon and early eve­ning. If you have asthma, ozone levels above green – especially above yellow – require your attention. During these times, outdoor physical activity should be limited. In addition, keeping win­dows in your home and vehicle closed with air vents closed or on recirculate should help. Ozone levels and alerts are readily avail­able and are typically part
of the weather forecast on
local radio and television stations. You can also check the air quality forecast for your area at AirNow.gov.

Interestingly, ozone gets the most press, but it is only one of many compo­nents of air pollution that can produce problems. Others include sulfur diox­ide and diesel exhaust particles. The total Air Quality Index (which takes into account not just ozone but these other pollutants as well) ranges from green (safe) to maroon (hazardous). Staying aware of this daily reading
can guide your decision on whether
to go outdoors or stay inside on any given day.

Medications Aspirin and NSAIDs Some peo­ple have asthma triggered by aspirin or aspirin-like drugs, such as ibuprofen
or naproxen. This class of drugs is known as NSAIDs (non-steroidal anti-inflammatory drugs).

In some people, asthma is triggered by
gastro-esophageal reflux, sometimes just called reflux or heartburn.

NSAIDs are more likely to be a problem as a trigger if you have nasal polyps and chronic sinusitis with asthma. In general, I have my asthma patients – even those without nasal polyps and chronic sinusitis but who have had problems with aspirin in the past – avoid NSAIDs. For most people with asthma and NSAID sensitivity, acet­aminophen is a safe alternative medicine to treat pain. It is best to discuss this issue with your personal physician.

In some cases, aspirin is absolutely required as a medication. In such sit-
uations, a procedure known as oral
desensitization can be successfully
accomplished under the guidance of
an allergist. Oral desensitization is the graded ingestion of aspirin, beginning with extremely low doses and progress­ing to higher and higher doses, until one reaches the standard dose, which he or she must remain on without inter­ruption every day to remain desensitized. As one might expect, this procedure does have its risks, and allergic reac­tions can be seen as the dose is raised during the process.

Beta-Blockers These medications are frequently used in the treatment of heart disease, hypertension, migraine headaches, and glaucoma. They work by blocking a cell receptor known as the beta-receptor. If asthma worsens after beginning these types of medicines,
an alternative drug needs to be used.

Other Situations Gastro-Esophageal Reflux (GERD) In some people, asthma is triggered
by gastro-esophageal reflux, some­times just called reflux or heartburn. Reflux can irritate the lungs directly
or cause nasal disease and sinusitis
that worsen asthma.

Most times, GERD is accompanied by symptoms such as heartburn, but not always. Most cases cannot be simply cured by avoidance of certain foods. In severe cases, surgery may be necessary.

Sinusitis Sinusitis, a bacterial in­fection of the sinuses, is a common complicating factor for asthmatics.
Sinusitis is treated with antibiotics.
Often brought about by allergens, smoke, and other irritants, it can often be prevented by avoiding the offend­ing substance. The use of some form
of nasal wash with saline may help as
a natural, non-medication method to treat or prevent sinusitis. In the long term, usually medications – and some­times allergy shots – may be needed to successfully treat the allergies that can lead to recurrent sinus infections.

Lastly, one important consideration is to get the influenza vaccination every fall. Influenza infection can cause ma­jor asthma problems; immunization reduces the risk.

Pregnancy While it is in the strict­est sense not an asthma trigger, I wanted to take a few moments to discuss asthma and pregnancy. In two-thirds of pregnan­cies, asthma stays at the same level or improves, but in one-third of women,
it worsens.

For pregnant women with asthma, the biggest risk to the unborn baby is not from the medications needed to control it but from uncontrolled asthma itself. An obstetrician and allergist work­ing together as a team is the best way to maximize control of the mom’s asthma and minimize risk to the unborn baby.

Exercise and Asthma Vigorous exertion will produce symptoms in many people with asthma. This is often referred to as exercise-induced bron­chospasm, or EIB for short. Asthma symptoms commonly begin six to
eight minutes into a vigorous workout. Typically, the symptoms stop with ces­sation of exertion and administration
of medications.

So, is my recommendation to avoid any type of physical exertion in people with asthma and EIB? Certainly not!

History is full of stories of elite
athletes with asthma who successfully competed in their sport. Often, the on­set of EIB symptoms can be prevented by the use of a bronchodilator inhaler 15 to 30 minutes before physical exer­tion. If you also use other medications for asthma, it is very important that you take them as directed to help prevent problems with EIB.

The times I do recommend avoid­ing vigorous exertion for asthmatics is when they are already fighting some type of illness or asthma flare-up, or when outdoor pollution levels are elevated. Exercising here may make problems worse and recovery may take longer.

Avoidance
There are many non-allergic factors that can trigger asthma. The most po­tent means of preventing problems is following a path of strict avoidance.

Dr. Stephen Apaliski has been a practicing physician for over 30 years and is board certified in pediatrics as well as allergy and immunology. He practices at the Al­lergy & Asthma Centres of the Metroplex and is on the medical staff at the Arlington Memorial Hospital in Arlington, TX.